{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T09:43:30Z","timestamp":1786441410968,"version":"build-2736575974"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J. Med. Toxicol."],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Phenobarbital has been successfully used in the emergency department (ED) to manage symptoms of alcohol withdrawal, but few studies have reported outcomes for ED patients who receive phenobarbital and are discharged. We compared return encounter rates in discharged ED patients with alcohol withdrawal who were treated with benzodiazepines and phenobarbital.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This is a retrospective cohort study conducted at a single academic medical center utilizing chart review of discharged ED patients with alcohol withdrawal from July 1, 2016, to June 30, 2019. Patients were stratified according to ED management with benzodiazepines, phenobarbital, or a combination of both agents. The primary outcome was return ED encounter within three days of the index ED encounter. Multivariate logistic regression identified significant covariates of an ED return encounter.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 470 patients who were discharged with the diagnosis of\u00a0alcohol withdrawal, 235 were treated with benzodiazepines, 133 with phenobarbital, and 102 with a combination of both. Baseline characteristics were similar among the groups. However, patients who received phenobarbital were provided significantly more lorazepam equivalents compared to patients who received benzodiazepines alone. Treatment with phenobarbital, alone or in combination with benzodiazepines, was associated with significantly lower odds of  a return\u00a0ED visit within three days compared with benzodiazepines alone [AOR 0.45 (95% CI 0.23, 0.88) <jats:italic>p<\/jats:italic>\u2009=\u20090.02 and AOR 0.33 (95% CI 0.15, 0.74) <jats:italic>p<\/jats:italic>\u2009=\u20090.007].<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Patients who received phenobarbital for alcohol withdrawal were less likely to return to the ED within three days of the index encounter. Despite similar baseline characteristics, patients who received phenobarbital, with or without benzodiazepines, were provided greater lorazepam equivalents the ED.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s13181-021-00863-2","type":"journal-article","created":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T16:02:55Z","timestamp":1635177775000},"page":"4-10","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal"],"prefix":"10.1007","volume":"18","author":[{"given":"Jacob A.","family":"Lebin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Mudan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"IV","given":"Charles E.","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph C.","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig G.","family":"Smollin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,25]]},"reference":[{"issue":"6","key":"863_CR1","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1111\/j.1553-2712.2000.tb02037.x","volume":"7","author":"JH Mandelberg","year":"2000","unstructured":"Mandelberg JH, Kuhn RE, Kohn MA. Epidemiologic analysis of an urban, public emergency department\u2019s frequent users. Acad Emerg Med. 2000;7(6):637\u201346.","journal-title":"Acad Emerg Med"},{"issue":"18","key":"863_CR2","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.1056\/NEJMra020617","volume":"348","author":"TR Kosten","year":"2003","unstructured":"Kosten TR, O\u2019Connor PG. Management of drug and alcohol withdrawal. N Engl J Med. 2003;348(18):1786\u201395.","journal-title":"N Engl J Med"},{"issue":"22","key":"863_CR3","doi-asserted-by":"publisher","first-page":"2109","DOI":"10.1056\/NEJMra1407298","volume":"371","author":"MA Schuckit","year":"2014","unstructured":"Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014;371(22):2109\u201313.","journal-title":"N Engl J Med"},{"issue":"2","key":"863_CR4","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1007\/s13181-014-0391-6","volume":"10","author":"PW Moore","year":"2014","unstructured":"Moore PW, Donovan JW, Burkhart KK, et al. Safety and efficacy of flumazenil for reversal of iatrogenic benzodiazepine-associated delirium toxicity during treatment of alcohol withdrawal, a retrospective review at one center. J Med Toxicol. 2014;10(2):126\u201332.","journal-title":"J Med Toxicol"},{"issue":"4","key":"863_CR5","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1016\/j.ajem.2012.12.029","volume":"31","author":"CR Stehman","year":"2013","unstructured":"Stehman CR, Mycyk MB. A rational approach to the treatment of alcohol withdrawal in the ED. Am J Emerg Med. 2013;31(4):734\u201342.","journal-title":"Am J Emerg Med"},{"issue":"3","key":"863_CR6","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1016\/j.jemermed.2012.07.056","volume":"44","author":"J Rosenson","year":"2013","unstructured":"Rosenson J, Clements C, Simon B, et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. J Emerg Med. 2013;44(3):592\u20138.","journal-title":"J Emerg Med"},{"issue":"2","key":"863_CR7","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.ajem.2019.01.053","volume":"38","author":"F Ibarra Jr","year":"2020","unstructured":"Ibarra F Jr. Single dose phenobarbital in addition to symptom-triggered lorazepam in alcohol withdrawal. Am J Emerg Med. 2020;38(2):178\u201381.","journal-title":"Am J Emerg Med"},{"issue":"7","key":"863_CR8","first-page":"1313","volume":"37","author":"SM Sullivan","year":"2019","unstructured":"Sullivan SM, Dewey BN, Jarrell DH, et al. Comparison of phenobarbital-adjunct versus benzodiazepine-only approach for alcohol withdrawal syndrome in the ED. Am J Emerg Med. 2019;37(7):1313\u20136.","journal-title":"Am J Emerg Med"},{"issue":"4","key":"863_CR9","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1016\/j.ajem.2019.01.002","volume":"37","author":"AC Nelson","year":"2019","unstructured":"Nelson AC, Kehoe J, Sankoff J, et al. Benzodiazepines vs barbiturates for alcohol withdrawal: analysis of 3 different treatment protocols. Am J Emerg Med. 2019;37(4):733\u20136.","journal-title":"Am J Emerg Med"},{"issue":"4","key":"863_CR10","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.ajem.2009.10.010","volume":"29","author":"GW Hendey","year":"2011","unstructured":"Hendey GW, Dery RA, Barnes RL, et al. A prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawal. Am J Emerg Med. 2011;29(4):382\u20135.","journal-title":"Am J Emerg Med"},{"issue":"10","key":"863_CR11","doi-asserted-by":"publisher","first-page":"e297","DOI":"10.1371\/journal.pmed.0040297","volume":"4","author":"JP Vandenbroucke","year":"2007","unstructured":"Vandenbroucke JP, Von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297.","journal-title":"PLoS Med."},{"issue":"8","key":"863_CR12","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1016\/S0196-0644(87)80520-6","volume":"16","author":"GP Young","year":"1987","unstructured":"Young GP, Rores C, Murphy C, et al. Intravenous phenobarbital for alcohol withdrawal and convulsions. Ann Emerg Med. 1987;16(8):847\u201350.","journal-title":"Ann Emerg Med"},{"issue":"1","key":"863_CR13","first-page":"139","volume":"58","author":"NS Miller","year":"1998","unstructured":"Miller NS, Gold MS. Management of withdrawal syndromes and relapse prevention in drug and alcohol abuse. Am Fam Physician. 1998;58(1):139.","journal-title":"Am Fam Physician"},{"key":"863_CR14","doi-asserted-by":"crossref","unstructured":"Thomas SH. Management of pain in the emergency department. Int Scholar Res Notices. 2013","DOI":"10.1155\/2013\/583132"},{"issue":"2","key":"863_CR15","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.annemergmed.2006.03.005","volume":"48","author":"AK Chang","year":"2006","unstructured":"Chang AK, Bijur PE, Meyer RH, Kenny MK, Solorzano C, Gallagher EJ. Safety and efficacy of hydromorphone as an analgesic alternative to morphine in acute pain: a randomized clinical trial. Ann Emerg Med. 2006;48(2):164\u201372.","journal-title":"Ann Emerg Med"},{"issue":"6","key":"863_CR16","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1097\/ADM.0000000000000430","volume":"12","author":"JD Pytell","year":"2018","unstructured":"Pytell JD, Rastegar DA. Who leaves early? Factors associated with against medical advice discharge during alcohol withdrawal treatment. J Addict Med. 2018;12(6):447\u201352.","journal-title":"J Addict Med"},{"issue":"2","key":"863_CR17","doi-asserted-by":"publisher","first-page":"398","DOI":"10.5811\/westjem.2017.10.35052","volume":"19","author":"LR Klein","year":"2018","unstructured":"Klein LR, Martel ML, Driver BE, et al. Emergency department frequent users for acute alcohol intoxication. West J Emerg Med. 2018;19(2):398.","journal-title":"West J Emerg Med"},{"issue":"2","key":"863_CR18","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1111\/acer.13559","volume":"42","author":"AM White","year":"2018","unstructured":"White AM, Slater ME, Ng G, et al. Trends in alcohol-related emergency department visits in the United States: results from the Nationwide Emergency Department Sample, 2006 to 2014. Alcohol Clin Exp Res. 2018;42(2):352\u20139.","journal-title":"Alcohol Clin Exp Res."}],"container-title":["Journal of Medical Toxicology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13181-021-00863-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13181-021-00863-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13181-021-00863-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T16:32:33Z","timestamp":1642091553000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13181-021-00863-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,25]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["863"],"URL":"https:\/\/doi.org\/10.1007\/s13181-021-00863-2","relation":{},"ISSN":["1556-9039","1937-6995"],"issn-type":[{"value":"1556-9039","type":"print"},{"value":"1937-6995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,25]]},"assertion":[{"value":"15 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2021","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2021","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 October 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}